61196 - Naval Station Great Lakes - Building 400 - Great Lakes - IL - 7212021 - Final.pdf

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PWD GREAT LAKES

Michelle Mosso

540 Cluverius Avenue Bldg 400

2021-07-21 Naval Station Great Lakes

NAVFAC MID ATLANTIC

cba

Thank you for choosing Protanic. We appreciate your business and will do our best to earn it every time. Below you will find a list of testing and/or inspections performed at the above mentioned location. Please review the following pages for results.

Mr. Mosso, Great Lakes, IL 60088

Results of Work Performed

GREAT LAKES, IL 60088-2814

2021-07-28

PO Box 80265 Saukville, WI 53080 www.protanic.com (262) 268-1150

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

July 28, 2021

NAVFAC Mid Atlantic Attn: Michelle Mosso PWD Great Lakes Great Lakes, IL 60088

Re: Work Performed July 21, 2021 Naval Station Great Lakes 540 Cluverius Avenue Bldg 400

Great Lakes, IL 60088

Dear Ms. Mosso, While performing testing procedures at the above mentioned location, the Protanic test technician reported the following:

1. The technician pumped 2” of water out of each of the Regular and Premium STPs.

Sincerely, Frank Grebas Vice President FG/cba http://www.protanic.com/

Equipment Detail and Certifications

Alert Tank Tester Wis. Material Approval No. - 20170001

Technician Information

Respectfully submitted, Equipment Utilized

Comments

Customer Name and Address Site ID/Facility Name and Address Test Date

Product State ID Capacity Construction Volumetric Result GPH Score

Tank Tightness Test Results

Ullage Result

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

PO Box 80265 Saukville, WI 53080 www.protanic.com (262) 268-1150

C28777Veeder Root bea843a6ALERT

IL-1413Illinois

492105WI Tank Tester

9fc213c0Petro-Tite

60088-2814ILGREAT LAKES

2023811400

Doug Metzker

PassPassFiberglass DW10000Premium

PassPassFiberglass DW15000Regular

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes

540 Cluverius Avenue Bldg 400 2021-07-21

Naval Station Great Lakes

NAVFAC MID ATLANTIC

Equipment Detail and Certifications

Petro-Tite Line Tester WI ILHR Material Approval No. - 2007002

Technician Information

Respectfully submitted, Product Piping System

Type Line Material

Precision Line

Test Result

Net Volume

Change

Equipment Utilized

Comments

LD Model

Line and Leak Detector Test Results

3 GPH Simulated Leak

Test Result

Test DateCustomer Name and Address Site ID/Facility Name and Address

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

PO Box 80265 Saukville, WI 53080 www.protanic.com (262) 268-1150

C28777Veeder Root bea843a6ALERT

IL-1413Illinois

492105WI Tank Tester

9fc213c0Petro-Tite

PassPLLD-0.0030 gphPassFlexiblePressurePremium

PassPLLD-0.0020 gphPassFlexiblePressureRegular

60088-2814ILGREAT LAKES

2023811400

Doug Metzker

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes 540 Cluverius Avenue Bldg 400 2021-07-21

Pressure Vacuum (PV) Vent Cap Test Product

Type Result Pass Fail PV Valve

Manufacturer Model Number

Manufacturer’s Specified Positive Leak Rate

” wc Manufacturer’s Specified Negative Leak Rate

” wc

Measured Positive Leak Rate CFH Measured Negative Leak Rate CFH

Positive Cracking Pressure ” wc Negative Cracking Pressure ” wc

Type Result Pass Fail PV Valve

” wc Manufacturer’s Specified Negative Leak Rate

” wc

Type

Result Pass Fail PV Valve

” wc Manufacturer’s Specified Negative Leak Rate

” wc

Type

Result Pass Fail PV Valve

” wc Manufacturer’s Specified Negative Leak Rate

” wc

Type Result Pass Fail PV Valve

” wc Manufacturer’s Specified Negative Leak Rate

” wc

Comments

Technician Signature:

Customer Name and Address Site ID/Facility Name and Address Test Date

-8.2+3.2

.2.31

-8+3

523OPW✔PUL

-8.2+3.1 .2.32

-8+3

523OPW✔RUL

60088-2814ILGREAT LAKES

2023811400

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes 540 Cluverius Avenue Bldg 400

2021-07-21 Naval Station Great Lakes

Doug

Tank Product Tank Product

In-Tank Gauging Probe Model In-Tank Gauging Probe Model Fill Sump Sensor(s) Model Fill Sump Sensor(s) Model Tank Overfill/High-Level Sensor Model Tank Overfill/High-Level Sensor Model

Tank Product Tank Product

In-Tank Gauging Probe Model In-Tank Gauging Probe Model Fill Sump Sensor(s) Model Fill Sump Sensor(s) Model Tank Overfill/High-Level Sensor Model Tank Overfill/High-Level Sensor Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Dispenser ID Dispenser ID

Dispenser Containment Sensor(s) Model Dispenser Containment Sensor(s) Model Dispenser Containment Float(s) Model Dispenser Containment Float(s) Model

Technician Name (Print): Technician Signature:

Facility Representative (Print): Facility Representative Signature:

Test DateCustomer Name and Address Site ID/Facility Name and Address

ATG Inspection

Certification

Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Make/Model of Monitoring System:

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P .

PO Box 80265 Saukville, WI 5308 www.protanic.com (262) 268-1150 0

Discriminating✔

5/6

Discriminating✔

9/10

Discriminating✔

3/4

Discriminating✔

7/8

Discriminating✔

1/2

Mag plus✔

Premium Mag plus✔

Regular

TLS-350

60088-2814ILGREAT LAKES

2023811400

Doug Metzker

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes

540 Cluverius Avenue Bldg 400 2021-07-21

Naval Station Great Lakes

Software Version Installed:

Yes No Is the audible alarm operational at the tank monitor?

Yes No Is the visual alarm operational at the tank monitor?

Yes No Were all sensors visually inspected, functionally tested, and confirmed operational?

Yes No If alarms are relayed to a remote monitoring system, is all communications equipment (e.g. modem) operational?

Yes No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product Water If yes, describe causes in comments, below.

Yes No Is all monitoring equipment operational per manufacturer's specifications?

* In Comments below, describe how and when these deficiencies were or will be corrected.

Yes No Was accuracy of system product level readings tested?

Yes No Were all probes reinstalled properly?

Yes No Were all items on the equipment manufacturer's maintenance checklist completed?

Comments

In-Tank Gauging / SIR Equipment

Does the ATG have a battery backup? If yes, is the battery backup functional? Tested and confirmed functional

The technician pumped 2" of water out of each of the Regular and Premium STPs.

121.00 kyliek Typewritten Text N/A kyliek Typewritten Text N/A kyliek Typewritten Text N/A kyliek Typewritten Text N/A

PO Box 80265 Saukville, WI 5308 www.protanic.com (262) 268-1150

P R O F E S S I O N A L T A N K I N V E S T I G A T I O N C O R P

Customer Name and Address

Facility ID Facility Name and Address

Test Date

Sensor Inspection/Certification

Was as system setup printed?

Sensor Location Type

Sensor in proper position when

ARRIVED?

Sensor in Alarm when

ARRIVED?

Functionality Test Result (Pass/Fail)

Sensor in proper position when LEFT site?

Sensor in Alarm when LEFT site?

Water present below sensor?

Is the sensor programmed for positive shutdown?

Did sensor shut down sub motor?

Yes

Yes

Yes Yes

No

No

Yes

Yes Yes

No

No

NoNoYesPassNoYesDiscriminatingDispenser9/10 NoNoYesPassNoYesDiscriminatingDispenser 7/8

NoNoYesPassNoYesDiscriminatingDispenser 5/6

NoNoYesPassNoYesDiscriminatingDispenser 3/4 NoNoYesPassNoYesDiscriminatingDispenser 1/2

NoNoYesPassNoYesBellPremium Interstitial

NoNoYesPassNoYesBellRegular Interstitial

NoNoYesPassNoYesTri-StatePremium STP

NoNoYesPassNoYesTri-StateRegular STP

60088-2814ILGREAT LAKES

2023811400

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes 540 Cluverius Avenue Bldg 400

2021-07-21Naval Station Great Lakes

NAVFAC MID ATLANTIC

http://www.protanic.com/

SHEAR VALVE INSPECTION

FUELING

DISPENSER

PRODUCT

Anchored Properly

Proper Height

YES NO YES NO

FUELING

DISPENSER

PRODUCT

Anchored Properly

Proper Height

YES NO YES NO

Customer Name and Address Site ID/Facility Name and Address Test Date

DieselDiesel

PremiumPremium

Mid-GradeMid-Grade

RegularRegular

DieselDiesel

Premium✔✔Premium

Mid-GradeMid-Grade

Regular✔✔Regular

9/10

DieselDiesel

Premium✔✔Premium

Mid-GradeMid-Grade

Regular✔✔Regular

7/8

Diesel

Diesel

PremiumPremium

Mid-GradeMid-Grade

Regular✔✔Regular

5/6

DieselDiesel

Premium✔✔Premium

Mid-GradeMid-Grade

Regular✔✔Regular

3/4

DieselDiesel

Premium✔✔Premium

Mid-GradeMid-Grade

Regular✔✔Regular

1/2

60088-2814ILGREAT LAKES

2023811400

PWD GREAT LAKES

Michelle Mosso

60088ILGreat Lakes

540 Cluverius Avenue Bldg 400 2021-07-21Naval Station Great Lakes

State of Illinois Office of the State Fire Marshal

Certification of Annual Inspection of All Dispenser Shear Valves

DPCS - Shear Valve Report (4/15)

KEEP FORM AT FACILITY

DO NOT MAIL OR FAX TO OSFM

(217) 785-1020 or (217) 785-5878

(1) OWNER OF TANKS : (2) FACILITY - name and address where tanks are located:

Zip:

Name: Name:

Street Address: Street Address:

City: County:City: State:

Contact Name:

Phone #: Fax #:

Contact Name:

Phone #: Fax #:

(Number of Shear Valves Inspected)

(Name of Tester)

(Date of Test)

(Signature of Tester)

The regulations of the Office of the State Fire Marshal ("OSFM") in Sections 175.210, 175.220, 175.230, 175.240 and 175.250 require that facilities dispensing motor fuels, such as attended and unattended self-service stations, full-service stations, fleet facilities and marinas, perform visual inspections of all under-dispenser shear valves at least annually.

The following criteria shall be used when inspecting the shear valves:

1) All shear valves shall be mounted using a listed rigid anchor.

2) All shear valves shall be mounted securely to the listed rigid anchor.

3) All shear valves shall be mounted at the proper height relative to grade following the shear valve manufacturer's installation instructions.

4) All shear valves shall be maintained in proper working condition.

5) In addition, the dispensers themselves will also be inspected when the shear valves are checked to confirm that each dispenser is properly and securely mounted to its island.

It is the duty of OSFM to make sure that these shear valves have all been inspected and found to be properly mounted, which is critical to their operation as a fuel shut-off safety device. The shear valves must also be verified as having been maintained in proper working condition, including having the fusible link correctly holding the valve arm, to ensure closure of the poppet valves when released upon a dispenser being damaged or a fire melting the link.

OSFM inspectors will confirm that all shear valves comply with the above requirements during an inspection. The OSFM inspectors will also check for documentation showing that a visual inspection of all shear valves has been performed annually.

This form, filled out and signed, can provide such documentation.

Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true.

By signing this document, I certify that I personally inspected the shear valves at the facility identified above by its OSFM Facility Number. I confirmed that all shear valves are properly secured and mounted correctly, that there are shear valves present on each dispensing device, and that all shear valves are in proper working order with fusible links and arms engaged.

Facility #:

(662) 420-8500

Michelle Mosso

2021-07-2110

(662) 420-8500

Michelle Mosso

60088ILGreat Lakes

605 Clark Avenue Building #221

Naval Station - Great Lakes

Lake

2023811400

Doug Metzker

Great Lakes

540 Cluverius Avenue Bldg 400

State of Illinois Office of the State Fire Marshal

Certification of Operational Testing of Emergency Electrical Shutoff Switches

DPCS - Operational Testing Report (4/15)

KEEP FORM AT FACILITY

DO NOT MAIL OR FAX TO OSFM

(217) 785-1020 or (217) 785-5878

(1) OWNER OF TANKS : (2) FACILITY - name and address where tanks are located:

Zip:

Name: Name:

Street Address: Street Address:

City: County:City: State:

Contact Name:

Phone #: Fax #:

Contact Name:

Phone #: Fax #:

(Number of Switches Tested)

(Name of Tester)

(Date of Test)

(Signature of Tester)

The regulations of the Office of the State Fire Marshal ("OSFM") in Sections 175.210, 175.220, 175.230, 175.240 and 175.250 require that facilities dispensing motor fuels, such as attended and unattended self-service stations, full-service stations, fleet facilities and marinas, have emergency electrical shutoff switches located so that every dispenser has a shutoff switch within 20 to 100 feet away. These emergency switches must be interconnected so that activation of any one switch will shut off power to all dispensers and pumps. Attended self-service stations must have an additional emergency shutoff at the control station.

Unattended self-service and fleet dispensing facilities must have an additional emergency shutoff at the dispensing island, but where these facilities have only one island, only one switch is required and must be located 20 to 100 feet from all dispensers or at a location as approved by OSFM. The emergency electrical shutoff switches must be tested annually.

It is the duty of OSFM to make sure that these electrical switches have been tested and are working prior to approving any motor fuel dispensing permit. If these emergency switches have not been tested prior to the Fire Marshal's inspection, the inspection staff of OSFM will have the switches tested during the inspection.

OSFM realizes that testing of the emergency electrical shutoff switches by our office may interrupt business activities.

Therefore, in order to avoid interruption, OSFM will allow the tank owner or their designated agent to certify on this form that the emergency electrical shutoff switches have been tested and all electrical power to all pumps, dispenser and dispenser lighting is disconnected all at one time.

Under the penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true.

By signing this document, I certify that I personally tested the emergency electrical shutoff switches at the above referenced facility. I turned the emergency electrical switches off, individually testing each such switch, and all electrical power to all pumps, dispensers and dispenser lighting disconnected all at one time. (This does not include any L.E.D. digital display units that are battery operated inside the dispenser housings.)

Facility #:

(662) 420-8500(662) 420-8500

Michelle MossoMichelle Mosso

60088ILGreat Lakes

605 Clark Avenue Building #221

Naval Station - Great Lakes

Lake

2023811400

Doug Metzker

Great Lakes

540 Cluverius Avenue Bldg 400

2021-07-21

Facility #: __________________

Facility Address: ____________________________________________________________

Annual Walkthrough Inspection Report: 20___ (year)

A/B Operator Signature (if applicable): _______________________________________________

Print Name of A/B Operator (if applicable): ____________________________________________

Inspections Required Annually (Inspections of piping sump areas must be performed by a certified employee of a contractor licensed in either the Install/Retrofit or Tank Tightness Testing modules.) All piping sumps areas shall be checked annually. Sump lids must be lifted and dispenser cabinets opened to inspect piping containment sump areas.

Contractor must initial and enter date of Annual Walkthrough Inspection.

Day/Month/Year of Inspection

Contractor Initials

Enter comments below corresponding to inspections listed at left.

Visual check for damage to piping containment sump areas: Check lids, covers & containment for damage & leaks.

COMMENTS & ACTIONS TAKEN:

Check sumps for the presence of regulated substances or any indication that a release may have occurred. Remove any liquid or debris if present.

COMMENTS & ACTIONS TAKEN:

Check that interstices of double wall containment sumps are free of water or product.

COMMENTS & ACTIONS TAKEN:

If applicable: Check gauge stick (manual tank gauging) or bailer (GW monitoring).

COMMENTS & ACTIONS TAKEN:

Contractor Employee Conducting Annual Inspection of Piping Containment Sump Areas:

1) Signature: _____________________________________

2) Print Name & Title: _____________________________________

Annual Test & Inspection: May be Performed by Contractor or A/B Operator Contractor or A/B Operator must initial and enter date of Annual Emergency Stops Test.

Day/Month/Year of Emergency Stop Test

Contractor or A/B Operator Initials

Enter comments below regarding Annual Emergency Stops Test. Attach OSFM Operational Testing of Emergency Stops Report to Walkthrough Inspection Report & keep at facility.

Test Emergency Stops for interconnection and STP shutdown.

Attach OSFM report form.

COMMENTS:

Contractor or A/B Operator must initial and enter date of Annual Shear Valve Inspection.

Day/Month/Year of Shear Valve Inspection

Contractor or A/B Operator Initials

Enter comments below regarding Annual Shear Valve Inspection. Attach OSFM Annual Inspection of Shear Valves Report to Walkthrough Inspection Report & keep at facility.

Check shear valves for proper height, secure mounting & free operation of trip arm & poppet.

COMMENTS:

DM07/21/2021

DM07/21/2021

DM07/21/2021

DM07/21/2021

DM07/21/2021

DM

07/21/2021

Protanic Inc

2023811400

Doug Metzker

Doug Metzker

Great Lakes540 Cluverius Avenue Bldg 400